Veracal 40

Indications

Veracal Tablets:

• Treatment of essential hypertension
• Management of angina pectoris and prevention of recurrent myocardial infarction
• Control of supraventricular arrhythmias

Veracal Injection:

• Treatment of tachycardias (e.g., paroxysmal supraventricular tachycardias)
• Management of atrial fibrillation with rapid ventricular response (except in WPWS)
• Treatment of atrial flutter with rapid conduction
• Addressing extrasystoles
• Management of acute hypertension and coronary insufficiency
• Prophylaxis and therapy for ectopic arrhythmias (especially ventricular extrasystoles) during halothane anesthesia or adrenaline administration

Note: Always follow the prescribed dosage from a registered healthcare provider.

Description

Veracal is a potent calcium ion influx inhibitor that limits the inward flow of calcium ions into cardiomyocytes, smooth muscle cells, and the His-Purkinje system. This sustained-release formulation of Veracal ensures prolonged action in the body.

Pharmacology

Verapamil is an L-type calcium channel blocker with well-established antiarrhythmic, antianginal, and antihypertensive properties. Immediate-release verapamil requires multiple daily doses, while extended-release options allow for once-daily administration. Due to its negative inotropic effects, verapamil should not be used in patients with severe left ventricular dysfunction or hypertrophic cardiomyopathy as it may worsen these conditions.

Dosage & Administration

Verapamil Tablets:

• The dose should be personalized based on individual needs and administered with food.
  • For hypertension: Start with 180 mg in the morning. If required, increase the dose to 240 mg or adjust by adding a second dose of 180 mg in the evening.
  • For angina: Typically 80 mg to 120 mg, 3 times daily.
  • For arrhythmias in digitalized patients: Administer 240 mg to 360 mg in divided doses, depending on severity.

Verapamil Injection:

• Adults: Start with 5 mg slowly via IV for tachycardias or hypertensive crises, repeating as needed. Drip infusion can be used at a dose of 5-10 mg/hour.
• Children: Adjust doses based on age and clinical response, starting from 0.75 mg for newborns to 5 mg for children aged 6-14 years.

Interactions

Veracal may interact with various drugs, including:

• Increased plasma levels: CYP3A4 inhibitors (e.g., erythromycin, ritonavir), cimetidine, and certain cardiovascular drugs (e.g., digoxin, beta-blockers).
• Decreased plasma levels: CYP3A4 inducers (e.g., rifampicin), and other substances such as phenobarbital.
• Other interactions: Increased risk of bleeding with aspirin, enhanced bradycardic effects with telithromycin, and potentiation of hypotension when combined with diuretics or vasodilators.

Contraindications

Veracal should not be used in patients with:

• Severe left ventricular dysfunction
• Hypotension or cardiogenic shock
• Sick sinus syndrome (unless an artificial pacemaker is present)
• Second or third-degree AV block (unless with a pacemaker)
• Known hypersensitivity to Verapamil hydrochloride

Side Effects

Common side effects (greater than 1% incidence) include:

• Digestive: Constipation, nausea
• Cardiovascular: Hypotension, edema, CHF, bradycardia, AV block
• Respiratory: Upper respiratory tract infections
• Nervous System: Dizziness, headache, fatigue
• Skin: Rash, flushing
• Hepatic: Elevated liver enzymes

Pregnancy & Lactation

• Pregnancy: Veracal should only be used during pregnancy if absolutely necessary, as it crosses the placenta.
• Lactation: Excreted in breast milk, so nursing should be discontinued during treatment.

Precautions & Warnings

Caution is advised for patients with:

• First-degree AV block, bradycardia, hypotension, or heart failure
• Atrial fibrillation or flutter, especially in pre-excitation syndromes like WPW
• Impaired liver or kidney function

Veracal may affect the ability to drive or operate machinery, particularly during the initial stages of treatment or with alcohol consumption.

Overdose Effects

Treatment involves supportive care. Beta-adrenergic stimulation and calcium infusion can be used to reverse overdose symptoms. Veracal is not removed by hemodialysis.

Therapeutic Class

Calcium Channel Blockers

Storage Conditions

Store below 30°C. Keep away from light and out of the reach of children.